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Nebraska rates for HCPCS V2628

Fabrication and fitting of ocular conformer

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$393.92 / $393.92 / $393.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$253.73 / $393.92 / $463.43
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$451.70 / $475.48 / $475.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.28 / $423.38 / $529.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$365.50 / $492.40 / $884.53
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.94 / $242.90 / $381.08
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$384.00 / $535.59 / $949.46
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$415.04 / $438.65 / $1,103.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.94 / $230.76 / $242.90